Book chapter
Chapter 18 - Interventional management of the patent ductus arteriosus
Neonatology Questions and Controversies: Neonatal Hemodynamics, pp.346-364
Elsevier, Fourth Edition
2023
DOI: 10.1016/B978-0-323-88073-2.00027-6
Abstract
As neonatal intensive care has evolved over the past decades, the clinical decision to perform definitive patent ductus arteriosus (PDA) closure in preterm infants has become increasingly fraught with uncertainty. The high efficacy of early pharmacotherapy and advances in noninvasive ventilation have contributed to a progressive and sustained reduction in referrals for surgical ligation among very preterm infants. This has been substituted largely by the expansion of percutaneous (or transcatheter) closure. Simultaneously, although this approach is deemed to be less invasive and with less adverse events, the evidence regarding appropriate timing and indication for referral remain unknown. There is a need for comprehensive methods of evaluation to reliably identify high-volume shunts whose definitive closure may result in measurable benefit. Post-closure physiology is characterized by a decrease in left ventricular (LV) preload, an increase in systemic vascular resistance, and a decrease in LV systolic performance. For infants who undergo a definitive procedure, post-closure cardiorespiratory instability may occur due to increased LV afterload. Milrinone prophylaxis may decrease the incidence of systemic hypotension and need for other inotropes/vasopressors in a subpopulation of high-risk infants. However, a large number of patients still develop respiratory instability, particularly oxygenation failure, despite the use of milrinone prophylaxis. This chapter will review the evidence regarding benefits and risks of definitive PDA closure in preterm infants and propose a pathophysiology-based management paradigm to guide periprocedural care.
Details
- Title: Subtitle
- Chapter 18 - Interventional management of the patent ductus arteriosus
- Creators
- Adrianne Rahde BischoffCarl BackesDany E. WeiszBassel Mohammad NijresPatrick J. McNamara
- Resource Type
- Book chapter
- Publication Details
- Neonatology Questions and Controversies: Neonatal Hemodynamics, pp.346-364
- Edition
- Fourth Edition
- DOI
- 10.1016/B978-0-323-88073-2.00027-6
- Publisher
- Elsevier; Amsterdam
- Language
- English
- Date published
- 2023
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984949228402771
Metrics
2 Record Views